What’s causing the bottleneck in disability management?

While it’s long been known that communication is a crucial piece of the disability management puzzle, a new study pinpoints a big reason for any bottlenecks: disability case managers and front-line supervisors. Information gaps around these two roles can create ripple effects through the entire organizational work disability management system, say researchers from the Institute for Work & Health (IWH).

In conducting interviews with 30 workers at three large municipal public services in Ontario, they found bottlenecks between the three core stakeholders: the disability management professionals, the frontline supervisors and the worker.

“Oftentimes, a breakdown could have a trickle-down effect where things would then be inflated and maybe not gain the right amount [of ] information at one point in time [which] could result in what we call avoidable disability days… And that could result in a delay and access to care, access to accommodation planning, access to their conversations occurring at the right amount of time, so that things just move smoothly,” says Arif Jetha, an IWH scientist and lead author of the study.

Case manager challenges

One challenge is case managers face barriers in their interactions with health-care providers, long-term disability insurers and workers’ compensation representatives, such as the limitation forms or being out of the loop in certain interactions. Case managers also spoke of the challenges of navigating collective agreements and privacy legislation.

“There’s only certain amounts of information that are available for disability managers to use and incorporate into the return-to-work plan. While that’s important for the worker because their rights and their information is protected, it creates a challenge obviously for someone who is trying to create accommodations and create … a plan to get someone back into their pre-job,” says Jetha.

Some organizations are clamouring to get that sort of information even though they don’t need it, says Tyler Amell, chief relationship officer and chief medical officer at CoreHealth in Calgary.

“[It’s about] focusing in on the positive aspects of what can this injured or ill person do to facilitate that return to work, in what’s called a graduated return-to-work plan under modified duties or modified hours.”

Mental health conditions are also a challenge, as case managers were less comfortable dealing with these kinds of disabilities, says the IWH study “Work Disability Management Communication Bottlenecks Within Large and Complex Public Service Organizations: A Sociotechnical Systems Study” in the Journal of Occupational Rehabilitation.

Front-line supervisors ‘unprepared'

As for the front-line supervisors, they were sometimes unaware of disability management policies and unprepared to engage with injured workers in these types of conversations, says Jetha.

“There was a lack of exposure on the supervisor side in terms of what types of questions to ask, the sensitivity toward [workers], not understanding how to approach those types of conversations and then on the disability management in trying to co-ordinate everyone to plan.”

Some supervisors were very proactive and knew how to be empathetic and supportive, he says.

“Others didn’t really know the purpose of the program, were maybe less effective, maybe didn’t realize that the words that they were using might have a negative impact on an injured worker’s perceptions.”

Relying on supervisors doesn’t really make sense because they haven’t been trained in work disability management,  says Amell.

“Some supervisors would be very adept and understand who the stakeholders are, how to communicate, how the policies must be supportive of that return-to-work process. Whereas if it’s not something they encounter very often, they’re going to need to rely much more readily on disability management case experts.”

And some supervisors don’t want a person back in the workplace unless they’re 100 per cent, he says.

“They look at it purely from a productivity perspective, rather than through the lens of the injured worker or through the organizational lens as a whole, who may be looking at an increase in insurance premiums as a result of these sort of activities.”

A large part of the problem is the professionalization and level of qualification of staff, says Wolfgang Zimmerman, president of the Pacific Coast University for Workplace Health Sciences and executive director of the National Institute of Disability Management and Research in Port Alberni, B.C.

“The vast majority of case managers don’t have any professional skills, so they don’t have communication skills.”

And you can’t expect the frontline supervisor to take the lead because that’s really not their job, he says. They should have some basic knowledge… but this is really not their job; their job is first and foremost to achieve results. It’s really [about] the skill and competence of the case manager.”

Possible solutions

When it comes to possible solutions, it’s about promoting goodwill and trust between workers and supervisors, especially pre-injury, says Jetha.

“With really strong relationships at the outset, those individuals would be more successful in communicating their details with regards to return to work and may be less suspicious of the organization, and the disability manager less suspicious of their supervisor.” 

It’s about fostering a positive culture in the workplace with strong levels of employee engagement, according to Amell.

“Increasing that level of stickiness, if you will, with the employer invariably helps with decreasing the overall number of injuries and illnesses and facilitates that return-to-work process for people who are excited about getting back into that positive culture.”

The IWH researchers also recommend uniform training to supervisors to increase awareness about their roles and responsibilities in the whole process, along with relevant communication strategies.

“This training… doesn’t have to be overly complex. Obviously, there’s a need to know the details and the requirements of a supervisor and their expectations in this process, but it’s also [about] small reminders, and ‘Try to check your feelings toward the worker in advance when they come to you with an injury,’” says Jetha.

“[It’s about providing] more positive types of messaging rather than skepticism and blame. Those kinds of little switches could actually have significant impacts across the entire organization.” 

ACCOMMODATION AT WORK 

• More than one in three employees with disabilities required at least one accommodation to work. 
• The most common type of accommodation is flexible work arrangements. 
• The second most common type is workstation modification. 
• Of those requiring accommodation, 59% had their needs met. 

Source: Statistics Canada